Is OCD a symptom of PTSD
Post Traumatic Stress Disorder (PTSD)
Post-traumatic stress disorder (PTSD) arises as a secondary reaction to one or more traumatic events that were experienced by oneself or on strangers.
Posttraumatic stress disorder (PTSD), PTSD
Post-traumatic stress disorder is delayed or protracted and is triggered by one or more traumatic events that are life-threatening, threatened with serious injury, or of catastrophic proportions that would cause profound despair in almost everyone. These include, for example, being exposed to physical or emotional violence, rape, kidnapping, terrorist attacks, war, experiencing disasters and diagnosing a life-threatening illness. The events can be experienced in oneself, but also in strangers. Furthermore, the trauma can be a one-off, unexpected event such as a traffic accident or a natural disaster or repeated, long-lasting trauma with an unpredictable course such as sexual or physical abuse in childhood, experiences of war or mass annihilation.
The lifetime prevalence of developing post-traumatic stress disorder is around 1.5-2% for the general population in Germany.
The likelihood of developing post-traumatic stress disorder depends on the type of trauma. Around half of the victims suffer from post-traumatic stress disorder following rape or war experiences, while those who experience e.g. traffic accidents or severe organ diseases (e.g. malignancies, heart attacks) are less likely to develop post-traumatic stress disorder (approx. 15%). Women are slightly more likely to develop post-traumatic stress disorder than men.
Post-traumatic stress disorder can be triggered by severe traumatic events such as physical violence, sexual abuse, accidents, natural disasters, war crimes or even receiving a diagnosis of a serious illness.
A post-traumatic stress disorder can also arise if the event was not experienced personally (e.g. act of war), but was "only" observed by the person concerned. The experience overwhelms your own psychological resources and coping strategies. Mostly, the self-understanding and the world is shaken.
Risk factors for developing post-traumatic stress disorder include a lack of social support, existing mental illnesses or trauma, traumatic childhood experiences and if the trauma was caused intentionally (e.g. rape). A very young or older age at the time of the trauma also affects the likelihood of post-traumatic stress disorder occurring.
Fateful events such as accidents or natural disasters are less likely to trigger PTSD. Post-traumatic stress disorder is more likely to be triggered by events that are associated with irretrievable loss, occur unexpectedly and cannot be controlled by the person concerned.
The pathogenesis of post-traumatic stress disorder is not yet fully understood. It is known that genetic, neurobiological and environmental factors interact with one another and that vulnerability or resilience in connection with the possible development of a post-traumatic stress disorder can be influenced. Studies suggest that a malfunction of the hippocampus leads to the storage of sensory impressions as memory fragments rather than in an orderly form. In the event of a flashback, these memory fragments are then called up.
In addition, neurobiological changes could be shown in the patients. They show an increased activity of the hormonal stress system and a decreased cortisol level. Epigenetic changes can also occur, which can continue to have an effect on subsequent generations.
Typical symptoms of post-traumatic stress disorder are so-called intrusions, i.e. the intensive remembering and reliving of the triggering situations in the form of images, film-like scenes or nightmares. Flashbacks can also occur. When exposed to a key stimulus, patients relive the traumatic event in thoughts, feelings, and images. In addition, the patients avoid conversations, situations, places, etc. that they associate with the event. Dissociative symptoms such as partial amnesia can also occur. Many patients also develop depression. They suffer from loss of interest, anhedonia, emotional numbness, and withdrawal. Some people even develop suicidal thoughts.
Furthermore, patients often show symptoms of overexcitation and anxiety. They suffer from insomnia, irritability, nervousness, difficulty concentrating, affect intolerance, palpitations and excessive vigilance. In childhood, for example, those affected show repeated play through of the traumatic experience, or behavioral problems such as aggressive behavior patterns.
With the presence of post-traumatic stress disorder, comorbidities such as depression, addictions or somatization disorders usually also occur.
The diagnosis of the disease is based on the clinical criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Diagnosis of post-traumatic stress disorder according to DSM-5
For the diagnosis of PTSD according to DSM-5, trauma must have been present. The person concerned must objectively have found himself in mortal danger or his physical integrity threatened.
The patient's symptoms last longer than a month and appear with a delay (> six months after trauma).
In addition, symptoms must be present from the following areas:
Reliving (there must be more than one symptom)
Patients suffer from reliving the situation. This can take the form of nightmares, intrusions, and flashbacks. Those affected experience psychological or physical stress during a confrontation, for example through being reminded of the situation or the event.
Avoidance behavior (more than one symptom must be present)
People with post-traumatic stress disorder often have a flattening of emotional responsiveness. They become alienated from the situation and sometimes only incompletely remember the triggering situation. You avoid thoughts, feelings, or memories of the event. In addition, those affected avoid trauma-associated stimuli, such as places or people that are reminiscent of the event.
Over-excitability (there must be more than two symptoms)
The patients suffer from symptoms of over-excitability such as sleep and concentration disorders. They are often jumpy and irritable.
Negative changes in thoughts and feelings (there must be more than two symptoms)
The patients rate the event as dysfunctional. They show fear, guilt, shame or even disgust.
The patients are psychosocially impaired in important areas of life by the disease.
General diagnostic procedure
The guideline recommends conducting a PTSD-specific interview and / or supplementary psychometric diagnostics to confirm the diagnosis.
The traumatic triggers need to be considered.
In order to make a diagnosis, it is important to distinguish the clinical picture from possible differential diagnoses such as an acute stress reaction or adjustment disorder. Relevant previous mental illnesses must also be taken into account. These include, for example, anxiety disorders, dissociative disorders, addictions, substance abuse and depression.
Fall in diagnosis
If there are clinically conspicuous comorbidities such as fear, addiction or dissociation, there is a risk of overlooking a post-traumatic stress disorder.
Subsyndromal disorders with clinical relevance such as intrusion and overexcitation symptoms without avoidance behavior must also be taken into account for the diagnosis.
The guideline warns against overlooking the diagnosis of post-traumatic stress disorder in suspicious, hostile and emotionally unstable behavior patterns. Even with medical interventions and diagnoses such as malignancies or patients after problem births, an increased risk of developing a post-traumatic stress disorder must be considered.
The reactions to a previous trauma are individual and very heterogeneous. They include in particular post-traumatic stress disorder (post-traumatic stress disorder, persistent personality disorder, etc.), anxiety disorders, depression and addictions. Some trauma sufferers do not develop a disorder at all.
For further information, please refer to the guideline.
Initial measures in the event of acute psychological trauma are the creation of a safe environment to protect against further trauma, the organization of a psycho-social helper system and the early involvement of a psychotherapist experienced with PTSD treatment. There should also be psychoeduction and information transfer regarding typical trauma symptoms and courses.
In the first contact of the patient after the trauma, which often takes place with the family doctor, human sympathy, conveyance of security and comfort are essential. Active listening to the patient and inquiries are also required.
Evaluation of the individual need for stabilization
The guideline recommends clarifying the individual need for stabilization as the next step. A sustainable therapeutic relationship is necessary for this. The patient should be involved in close diagnostic and therapeutic care. The patient's options for affect regulation, self and relationship management and social skills should be evaluated so that they can be taken into account in treatment planning. In addition, an assessment of the person's tendencies to endanger himself and others is recommended. In addition, intra- and interpersonal resources should be built up. Adjuvant pharmacotherapy may be necessary to support symptom control. The particular risk of addiction for those affected by post-traumatic stress disorder must be taken into account here. The guideline also recommends evaluating whether adjuvant procedures such as occupational therapy, art therapy, music therapy, body and movement therapy or physiotherapy are indicated.
Treatment should be initiated promptly if serious symptoms appear at the outset and if there is a high level of stress.
Therapeutic strategies for post-traumatic stress disorder
The guideline recommends a confrontation with the memory of the triggering trauma. In particular, traumatically fixed memories and sensory fragments should be processed. This is intended to achieve integration. Clinical comorbidities must also be taken into account during therapy. The guideline recommends that trauma-adapted psychotherapy should be offered to everyone affected.
Trauma-focused therapies such as Eye Movement Desensitization and Reprocessing Therapy (EMDR) are available to treat post-traumatic stress disorder. Cognitive behavioral therapy and behavioral therapy based on the Foa exposure paradigm are also used in post-traumatic stress disorder.
Contraindications to trauma-processing procedures
The guideline specifies the following contraindications for trauma-processing procedures:
- lack of affect tolerance
- persistent severe tendency to dissociate
- uncontrolled auto-aggressive behavior
- Inadequate distancing from the traumatic event
- high acute psychosocial and physical stress
- acute psychotic experience
- acute suicidality
- Serious self-harm / problems with aggressiveness from others in the last four months
- Contact with the perpetrator with a risk of trauma
If there are contraindications for confrontational trauma processing, this can only take place if external security and sufficiently good emotion regulation / adequate stabilization is guaranteed.
In Germany, the antidepressants paroxetine and sertraline are approved for the indication “post-traumatic stress disorder”. These can be used alongside psychotherapy for pronounced depressive symptoms, anxiety and irritability. If the effectiveness is insufficient, an off-label therapy attempt with the selective norepinephrine reuptake inhibitor (SNRI) venlafaxine can be carried out. MAO inhibitors and other antidepressants are also used for therapy in post-traumatic stress disorder.
Before initiating pharmacotherapy, a risk-benefit assessment must be made.
For further information, please refer to the specialist literature / guideline.
The course of post-traumatic stress disorder is individual. The majority of patients can be cured. About half of those affected show a spontaneous remission of the disease. In about 30% of the cases, the disease can become chronic and last for many years and / or even lead to a permanent change in personality.
It could also be shown that an increased number of trauma in childhood and adolescence is associated with an increased morbidity from mental and physical illnesses. Life expectancy is then also reduced.
It is difficult to prevent post-traumatic stress disorder. There is currently no reliable method that can prevent post-traumatic stress disorder from occurring.
In general, it can be said that it can be helpful if those affected seek psychological help as soon as possible after experiencing a trauma. As a rule, the earlier treatment is given, the better the prognosis.
Those affected by post-traumatic stress disorder show a particular risk of addiction.
- AWMF S3 guideline: Post-traumatic stress disorder ICD 10: F43.1 AWMF register no. 051/010
- Bandelow et al. (2008): World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders - First Revision. The World Journal of Biological Psychiatry; 9: 248-312. DOI: 10.1080 / 15622970802465807
- Breslau (2009): The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma violence abuse; 10: 198-210. DOI: 10.1177 / 1524838009334448
- Frommberger et al. (2014): Post-Traumatic Stress Disorder - A Diagnostic and Therapeutic Challenge. Dtsch Arztebl Int; 111: 59-65. DOI 10.3238 / arztebl.2014.0059
- Foa et al. (2009): Effective treatments for posttraumatic stress disorder. Practice guidelines from the International Society for Traumatic Stress Studies. New York: Guilford.
- Foa et al. (2007): Prolonged Exposure Therapy for PTSD. New York: Oxford University Press 2007
- Hofmann (2006): EMDR in the therapy of psychotraumatic stress syndromes. Stuttgart: Thieme
- Kessler (2000): Posttraumatic Stress Disorder: the burden to the individual and to society. J Clin Psychiatry Suppl; 5: 4-12
- Klengel et al. (2013): Allele-specific FKBP5 DNA demethylation mediates gene - childhood trauma interactions. Nature Neuroscience; 16: 33-41. DOI: 10.1038 / nn.3275
- Meaney et Szyf (2005): Environmental programming of stress responses through DNA methylation: life at the interface between a dynamic environment and a fixed genome. Dialogues Clini Neurosci; 7: 103-23
- National Institute for Clinical Excellence NICE: Posttraumatic stress disorder - the management of PTSD in adults and children in primary and secondary care. London: National Institute for Clinical Excellence 2005
- Stein et al (2009): Pharmacotherapy of posttraumatic stress disorder: a review of meta-analyzes and treatment guidelines. CNS Spectrums; 14: 1: 25-31
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